Q&A with Dr Chris Zink and Dr Ellen Martens

1. Post-injury, owners are ofteninstructed to keep their animals oncrate rest or very reduced exerciseswhich, particularly in the case ofyoung animals, can be very hard. Doyou have any tips to give to ownersin this early recovery period?

Ellen: Yes indeed, this can be verychallenging for some dogs! But ina lot of cases, it is so important tofollow the instructions regardingrestricted activity. It is needed to helpthe healing process and to minimizethe risk of complications. I think everydog benefits with crate training. Makesure that your dog links the cratewith something fun or with a positivereward. For some dogs, it helps to putthe crate in a silent environment withas less triggers as possible. Make surethat you lower the amount of foodduring this period because the dog hasless activity and might receive morefood rewards. Mental games becomemore and more popular and can be ananswer to mentally fatigue your dog.Also, try to organize the controlledleash walks during the day so that yourdog doesn’t have to be in the crate fora long period of time. And last but notleast, make sure that the crate is not toosmall, not too big, and safe - watch outfor slippery floors!

Chris: First, I think we need to be veryclear about what we mean by craterest. Studies have shown that craterest rapidly reduces adog’s muscle strengthand aerobic activities,whereas just a smallamount of movement,such as that used inactivities of daily living,can help a dog maintainits fitness level for muchlonger. So I often prescribe ‘room rest,’in which the dog is confined to a smallroom with good flooring, such as acarpeted bathroom, instead of craterest. In any case, the key to resting adog is to just rest its muscles, not itsmind. Scenting games, puzzle gamesand one-on-one training of nonconcussivemanoeuvres will occupy adog’s mind during a less active period.

2. At what point in recovery, postsurgery, do you think is the optimumtime to begin therapy?

Ellen: As in human medicine: as soon aspossible! Of course, not every treatmenttechnique can be applied duringevery stage of recovery, this is wherethe knowledge and experience of thetherapist comes in. For example, notevery dog or every pathology benefitsfrom hydrotherapy, especially not in theearly stages of recovery.

3. Rushing rehabilitation canincrease the risk of setbacks or reinjury. What do you feel is a realistictime frame to recover from an injurythat has required surgery?

Ellen: Of course, this depends ondifferent factors: the injury itself,complications, activity level of the dog,age of the dog, co-morbidities, musclewasting, etc. Overall we can say that ittakes between 3 to 6 months to havethe dog back to full activity withoutrestrictions. For a sporting dog, it cantake even longer before they are in fulltraining again.

4. Are there any tips you can giveon key changes in movement ormusculature that may indicate aninjury is on its way?

Chris: For performance dogs, competitors should view videos toconfirm that their dogs are using the correct lead legs on jumps and turns, and look comfortable in all aspects ofthe sport

5. After cruciate surgery, owners areoften advised that the other leg mayalso succumb to cruciate injury. Isthere anything that can be done toprevent this?

Ellen: Full recovery and rehab ofthe surgery leg is really important.Sometimes we see that dogs keepcompensating during explosiveactivities and thus keep overloadingthe other non-surgery leg with a higherrisk of cruciate injury on that side. Fullweight bearing during all activities,good muscle mass and strength, goodcoordination and proprioception area must. Of course, we can not controleverything (conformation and geneticsplay a role too) but these are alreadysome good factors to minimize the risk.

6. Can a dog diagnosed with arthritis still work or do agility?

Chris: For the vast majority of dogs,arthritis can be managed well usinga multi-modal approach that wouldinclude nutrition, supplements,pharmaceutical pain relief andappropriate, non-concussive fitnessexercises. Many dogs with arthritis arecompeting at international-level sports.

7. Do you think it really matters if adog carries a few extra pounds?

Chris: Absolutely. That is dead weightthat makes all motions more difficultand more stressful on the body.

8. When a dog is diagnosed with aneurological condition, can therapyreally help?

Ellen: Of course, this depends fromcondition to condition. Some dogscome in without diagnostics so thatthe prognosis is unpredictable, butoften our neuro examination withinterpretation of the clinical signs givesus an idea if the dog has less chanceto walk again. We see a lot of neurodogs in our rehab centre, conservativeor postoperative with a lot ofvariation of clinical signs. I have tosay that we are able to rehab mostof the dogs to independent dailyactivity again. Our rule of thumb isthat we have to see improvementfrom week to week. As long aswe keep on seeing improvement,it is worth to move on with thetherapy.

9. In some cases, therapy has to be limited due to lack of funds or ability to reclaim on insurance. Are there any valuable exercises you suggest that owners can do at home?

Ellen: It is hard to give exercises that are good for every dog in every condition. If we have dogs that are limited to come to therapy, we try to spread our sessions during the recovery period and guide the patient and the owners with a home exercise plan.

Chris: There are many at-home exercises that can be performed but these should be specific to the dog’s size, structure, and injury and they should be prescribed by a rehabilitation professional. 10. More and more owners want to go down the 'natural' or homeopathic route these days, however, the supplement market is a minefield! Are there any supplements or ingredients you have found particularly beneficial in the recovery stage and ongoing?

Ellen: It is indeed a minefield and not all supplements are from good quality. In Belgium, we work a lot with Flexadin advanced, Cosequin, Primeval and Seraquin. I always suggest to ask advice to the vet in charge of the treatment of the dog.

Chris: Here are the supplements that I recommend and the evidence basis (scientific references) for them:

- Joint-Protective Nutraceuticals – A dose of about 20 mg/lb of glucosamine per day is recommended. Products designed for dogs include Dasuquin Advanced, Glycoflex II or III and others. Natural sources of glucosamine include trachea (1 oz = 1400 mg) and chicken feet (one foot = 400 mg). The Evidence: A 2018 metaanalysis of publications on a variety of dietary supplements for osteoarthritis in humans suggested improvement of pain and function with glucosamine, chondroitin, MSM and avocado soybean unsaponifiables, although they stated that there was also a need for more higher quality evidence (1).

- Omega-3 Fatty Acids – The recommended dose is 15 mg/lb of DHA. Make sure the source is tested for heavy metals. Good sources include Grizzly Salmon Oil and Nordic Naturals, but there are others as well. The Evidence: Two 2016 metastudies concluded that there is evidence for the systemic anti-inflammatory effects of omega-3 fatty acid supplementation (2, 3).

- Probiotic supplement designed for dogs – Two good sources are Geneflora and VisBiome (aka VSL-3). The Evidence: Probiotics can reduce the severity of canine allergies, improve inflammatory bowel disease, and boost responses to vaccines (4, 5, 6).

- Antioxidants – Antioxidants are most effective if fed in their native form. Blueberries are very high in antioxidants, and an easy way to provide them is by purchasing freezedried blueberries. Give about 10 blueberries for a small dog, 20 for a medium dog and 30 for a large dog once a day in their food. Available at Amazon. The Evidence: Two studies show that diets containing antioxidants improved cognitive function in old dogs (7, 8), so why not provide antioxidants to all dogs that need optimum cognitive function.

- Amino acids – Many dog foods, particularly dried foods provide the vast majority of their amino acids from plant sources since these are cheaper. Dogs need certain essential amino acids and other nutrients that can only come from animal sources. A supplement called ProBalance by AVN is recommended to ensure that your dog is receiving an abundance of the correct, animal-sourced amino acids. This supplement has been designed by an independent, board-certified veterinary canine nutritionist to supply all of the essential, animal-sourced amino acids and building blocks for important nutrients, like taurine, that often are lacking in commercial dog food and homemade diets.

REFERENCES:

Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis.

Effect of Marine-Derived n-3 Polyunsaturated Fatty Acids on Major Eicosanoids: A Systematic Review and Meta-Analysis from 18 Randomized Controlled Trials.

Atopic dermatitis and the intestinal microbiota in humans and dogs.

Supplementation of food with Enterococcus faecium (SF68) stimulates immune functions in young dogs.

Comparison of microbiological, histological, and immunomodulatory parameters in response to treatment with either combination therapy with prednisone and metronidazole or probiotic VSL#3 strains in dogs with idiopathic inflammatory bowel disease.

Cognitive enhancement in old dogs from dietary supplementation with a nutrient blend containing arginine, antioxidants, B vitamins and fish oil.

Strategies for improving cognition with ageing: insights from a longitudinal study of antioxidant and behavioural enrichment in canines.